1. Forging non-traditional
stakeholder partnerships
against malnutrition
Resources for Improving Birth Outcomes - RIBO
Dr. Pamela Mukaire
CCIH 29th Annual Conference, 2015 – Washington, DC

2. Food, Health at Birth and During Infancy
• Fetus nourished at the expense of mother’s tissue,
IF NECESSARY
• Mother’s childhood nutrition (her height) affects
her child’s birth weight
• Mother’s diet during pregnancy affects birth weight
• Poverty-stricken communities – birth weight
increase when mothers diet is improved
• Increased birth weight = increase in infant/child
survival rates
• Well nourished babies – healthy babies, health
communities
• Nutritional deficiencies cause increased child
mortality

3. The Malnutrition Problem in Uganda
• Malnutrition is a key variable of the three related
welfare dimensions of monetary poverty, food security
and nutrition
• Malnutrition is associated with more than half of all
childhood deaths worldwide,
• poor child-feeding practices,
• food shortages or
• poor access to adequate sanitation and healthcare.
• Most vulnerable
• young children, women, the elderly
• people with chronic illnesses e.g. HIV, TB, cancer etc.
• Uganda 12% of children under age 5 are moderately or
severely underweight

4. A Burden or Challenge?
• 2013 WHO study
• Over 400 MCH healthcare providers interviewed
• Key finding: Infant feeding challenges – largely due to lack of
food
• Majority of providers identified malnutrition as a big concern –
both in HIV exposed and unexposed infants & children
• Of the 400 interviewed, ONLY 1 Clinical Officer personally
took up the challenge to mobilize the community to address
the malnutrition treatment service gap!!!
• Sister Proscovia Menya – Clinical Officer
• “Nurse, here are your children” - Underweight (low weight for
age), wasting (low weight for height), and stunting (too short
for age), cases in HIV-exposed babies especially.
• Burden or challenge? – home made soy milk inspires
community-based malnutrition management project.

5. Partnership Roles
Midwives & Nurses: clinical assessments
VHTs: case identification, referral,
outreach, follow-up
Community members: garden care and
management
Academia: Researchers to assist with
CBPR, community and home based
nutrition assessments, data collection
and tracking
ALL: work in the garden, outreach,
garner resources

6. Programs Services
• Nutritional status screening - (moderate or severe,
acute) and HIV status
• Health nutrition services, counseling and education
outreach – integrated for HIV, TB, FP, nutrition,
immunization, de-worming
• Promotion of breast feeding
• Growth monitoring promotion and infant and young
child feeding
• Home-based care
• Clinic/community managed vegetable garden.

7. Highlighting the Community Garden
Sister Proscovia Menya
Second Garden Nursery
“Container” Garden for
backyard farming

8. Highlighting the Community Garden
Kyiimaka HC 2 – Second Garden Nurses and Community Mother
& Father

9. How Resources are Mobilized.
Community
Father
Clinical Officer, and Nurses

10. • Year 1- Thriving gardens, food preparation demos, and
growth monitoring
• Year 2- Different reasons and goals for partner members
• Funders fail to tap into potential community power
• As supporters – ask, “how best to contribute to this power that
resides with the community to solve its problems
• Year 3- Back to Community-Based Malnutrition
Management of Acute Model (CHAM)
Partnership expectations

11. • Lack of gardening tool - no hoes, watering cans, horse pipe, etc.
• Cooking demonstration equipment - no mortal, buckets, water jerricans, charcoal,
stove, saucepans for cooking, warming and storing milk, food warmers
• Poor documentation of success - lack of camera, record keeping
• Basic clinical assessment tools- tape measures, weight scale and boards ….
• VHTs training updates
• Lack of ready to use foods for those with severe nutrition
Resource Challenges – Kyiimaka HC 2

12. New Partner
Resources
for
Improving
Birth
Outcomes
Resources
for
• The mission of RIBO is to work collaboratively with
institutions of health and academia to improve maternal
and child health outcomes and general population
health and well-being. We achieve our mission through
three basic activities: research, education, material
provisions and advocacy.
• Small group of “young professionals” – interested in
contributing to and supporting local MCH efforts in
semi-urban and rural
• 2 individual programs, 3 HCs, and 3 churches

13. Why Community-based Management of Acute Malnutrition
(CMAM)?
• Apart from main hospital – no known nutrition rehabilitation center in this
county
• Hospital very expensive and hard to reach for most mothers (who are the
primary home care takers can’t stay away from home for too long)
• “Although children suffering from medical complications like hypothermia,
hypoglycemia or severe dehydration are still sent for inpatient care at
hospitals, CMAM brings brought treatment for malnourished children
directly into the home.”
• Creates models of care, community support and builds social capital

14. STRENGHT in partnerships
• Division of labor
• Contribution of resources
• Dialogues of courage
• Shared knowledge and skills – share new knowledge, improve skills, learn simpler ways to
best accomplishing goals
• Support system of people who understand the challenges of the community and are able
to address new problems as they arise
• Program ownership by the community empowers mothers and their spouse far more than
a clinic based model does
• We monitor each other and all grow from collaboration …

15. The rewards of persevering
• Its depressing to see malnourished mothers- underweight, sickly
babies, not healing quickly for mother, constant anemia, and wasting.
• Seeing babies and mother gain weight and return to normal duties
• Seeing the community take ownership of the project and utilize their
own resources

16. THANK YOU!
Questions and
Comments Please!